B超引导下微创经皮肾取石治疗上尿路结石的临床分析

Clinical Analysis of B ultrasound-guided minimally invasive percutaneous nephrolithotomy for upper urinary tract stones

目的探讨B超引导下微创经皮肾取石术(MPCNL)治疗上尿路结石的临床效果。方法 2006年9月至2009年6月92例上尿路结石患者在B超引导下行微创经皮肾镜取石术治疗,术后输尿管内均放置双J管,所有患者均随访1～3个月。结果行MPCNL治疗的92例患者均一期单通道取石,结石清除率84.5%;手术时间(82.2±10.8)min;术中出血(102±18.6)ml;术中输血2例(2.2%),术后并发大出血1例(1.1%),经输血对症治疗后行开放手术治疗痊愈;住院时间(5.8±1.2)d;尿液转清时间(2.7±1.0)d;术后感染6例(6.5%)。有14例(15.2%)存在不同程度的结石残留,其中9例(9.8%)行二次取石,2例(2.2%)行三次取石,3例(3.3%)术后行体外震波碎石。结论超声引导下行MPCNL治疗上尿路结石具有创伤小、高效安全、术后恢复快和并发症少等优势,值得临床推广应用。

Objective To investigate the clinical effect of minimally invasive percutaneous renal lithotripsy （MPCNL） treatment of urinary tract stones. Methods From September 2006 to June 2009, 92 cases of patients with upper urinary tract calculi were performed ultrasound minimally invasive percutaneous nephrolithotomy down lithotomy. After operation,double-J ureteral were placed inside the tube and all patients were followed up for 1 ~ 3 months. Results 92 patients in the treatment of MPCNL were taken stones at one time and stone clearance rate was 84.5%; the operative time was （82.2 ± 10.8） min; the blood loss was （102 ± 18.6） ml; intraoperative blood transfusion in 2 cases （2.2%）, surgery complicated with bleeding in 1 case （1.1%）,After blood transfusion, cured in the treatment of open surgery; hospital stay （5.8 ± 1.2） d; urine turned clear and the time （2.7 ± 1.0） d; postoperative infection in 6 cases （6.5%）.There were different degrees of residual stones in 14 cases（15.28%）, of which 9 cases （9.8%） underwent secondary stone taking, 2 cases （2.2%） had to undergo the third time, 3 cases （3.3%） underwent extracorporeal shock wave lithotripsy. Conclusion Ultrasound-guided treatment of urinary tract stones down MPCNL with trauma is efficient and safe, rapid postoperative recovery and fewer complications, it’s worthy to be popularized.